Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Monday, November 27, 2017

The minus signs in the above might confuse you so let me make this clear -- a negative number means you pay less in taxes, a positive number means you pay more -- except for the poor, for whom the calculus also accounts for reduced federal subsidies for health care. The Cut Cut Cut! act also adds $1.4 trillion to the deficit over the next ten years. So if you make less than $75,000 a year, the Republicans -- the party of small government and fiscal responsibility -- want to raise your taxes to partially pay for a massive tax cut for rich people.

Speaking now for the academic community, the House bill does the following:

Imposes a 1.4% tax on income from university endowments. This income is used to provide financial aid, graduate student fellowships, summer internships and research awards for students, and faculty research.

Taxes tuition waivers for graduate students as income. Since the students will be taxed on income that they never actually see in the form of money, it will be impossible for them to pay it. That means only people with rich parents will be able to get doctorates.

Eliminates the tax deduction for student loan interest, further restricting educational opportunity for low and moderate income people.

Of course, Republicans don't like universities or people with advanced degrees because they don't like truth and knowledge. They prefer a world in which they can spout lies and nobody will sort out truth from falsehood. Maybe they'll get their wish.

Wednesday, November 22, 2017

For some reason the corporate media doesn't bother to point out that the Republican tax bill, whether the House or Senate version, will perforce immediately cut Medicare by $25 billion and force ever deeper cuts in the years ahead. This is because existing law requires cuts in spending to make up for tax cuts. The congressional leadership and the head of the Office of Management and Budget are hostile to Medicare -- they want to eliminate it entirely. This is true.

Remember that in the 2010 midterms, the Republicans claimed that the Affordable Care Act cut Medicare and that they were the defenders of Medicare against Democrats. The claim about the ACA was misleading at best -- it reduced some payments to providers but did not cut benefits. But enough voters believed them to produce big Republican gains. The current Resident campaigned on a promise to protect Medicare and Medicaid, but of course he was lying, as he is every time his lips move.

Do you or your parents or grandparents depend on Medicare? You might mention this to them, since CNN won't.

So you're thinking, "I don't care, I want a tax cut." Well you aren't going to get one. The Republican bill raises federal income taxes and reduces income for people making less than $70,000/year, and does nothing for people making less than $200,000/year. All of the tax cuts go to wealthy people and mostly to extremely wealthy people.

Now, this probably doesn't sound like the greatest political calculation. But you might be wrong about that. The tax increases on moderate income people won't become apparent for a few years; and that cuts in Medicare won't happen right away either. Because capitalists are stupid, if the bill passes the stock market will stay bubbly and since we're already in a growth phase that will likely continue for a while. The catastrophe may not be obvious to voters by November of next year, and if Collender and Krugman are telling them to be worried that will be a fart in a whirlwind.

However, 2018 is likely to be a bad election cycle for them after which it's just going to get worse. Ultimately, this will be politically, as well as economically, catastrophic. So why are they in such haste to do it?

That's easy. It's because their true constituency is the wealthy donor class, led by the Koch brothers. They are under orders. And they won't have to worry about the political catastrophe if the U.S. is no longer a republic, which is also part of the agenda. So maybe they aren't so insane after all.

Thursday, November 16, 2017

I've mentioned here before the rapid advances in precise gene editing. We're getting close to being able to correct specific genetic defects in germ line cells. George Church (who was my high school classmate for two years until they kicked me out) offers a fairly technical discussion of the state of the art. He is quite solicitous of people who have moral objections to the destruction of human embryos, however sincere I don't know, but his point is that fixing germ line cells results in fewer destroyed embryos than the current technology, which is to test gametes for genetic defects and discard the bad ones.

The other serious ethical cloud over germ line editing is that you could create designer babies -- super intelligent, athletic, long lived, tall, physically beautiful, whatever. Actually we are very far from that and it might never be really feasible for two reasons. First, the phenotype -- the nature of the mature organism -- depends on the interaction of the generic heritage with the environment, with all of the experiences of the organism as it matures. A baby designed for a particular environment might not give you the results you want if the environment is a bit off, and it isn't fully controllable. Another reason is that these sorts of qualities aren't determined by a single gene either. They are really the result of complex interactions among many genetic traits and the environment, and we are a long way from even beginning to figure out the picture of what predisposes a baby to being smart -- not to mention there are various ways of being smart.

In fact optimizing for one characteristic could mean creating bad results in other areas. Maybe your supersmart baby will turn out to be a psychopath, or your designer NBA superstar will drop dead at age 42. George doesn't seem to worried about any of this but he does suggest that if you're trying to fix a defect, you will probably aim for better than average. And that's really an ethical quagmire. Where is the line between fixing a defect and making a person better than average? What height or IQ or facial deformity crosses the line from being on the short side or not the brightest bulb on the tree or plain looking, which it would not be ethical to fix, to having a defect or disability that is ethically fixable?

However, my view is that all of this hand wringing is for nought because no matter what politicians or scientists or ethics panels in the U.S. think, if it looks like it's possible to create a superbaby, somebody is going to do it. There are rich people in every corner of the earth who will want it, won't have scruples, and will pay for it. It will happen.

Monday, November 13, 2017

It seems that highly credible reports of molesting a 14-year-old girl are enough to make some conservative pundits and maybe a couple of senators think that the subject should not be a U.S. senator. On the other hand a lot of them don't think so. However, Roy Moore was obviously not qualified to be a U.S. senator long before we found out any of this.

He is a raging bigot and a Christian dominionist whose political objective is to impose religious tyranny on the nation. He has twice been removed from the bench for flouting the constitution of the United States. All of that was more than fine with the majority of Alabama voters, it's what they want in a Senator. As DR Tucker reminds us, they live in an alternative reality. The allegations can't be true because they were reported by the Washington Post, and anyway they can't be true because the voters don't want them to be true. As David Roberts writes (and as quoted by Tucker):

The US is experiencing a deep epistemic breach, a split
not just in what we value or want, but in who we trust, how we come to
know things, and what we believe we know — what we believe exists, is
true, has happened and is happening.

The primary source of this breach, to make a long story
short, is the US conservative movement’s rejection of the mainstream
institutions devoted to gathering and disseminating knowledge
(journalism, science, the academy) — the ones society has appointed as
referees in matters of factual dispute.

In their place, the right has created its own parallel set of institutions, most notably its own media ecosystem. But the right’s institutions are not of the same kind as
the ones they seek to displace. Mainstream scientists and journalists
see themselves as beholden to values and standards that transcend party
or faction. They try to separate truth from tribal interests and have
developed various guild rules and procedures to help do that. They see
themselves as neutral arbiters, even if they do not always uphold that
ideal in practice. . . .

But the right did not want better neutral arbiters. The
institutions it built scarcely made any pretense of transcending
faction; they are of and for the right. There is nominal separation of
conservative media from conservative politicians, think tanks, and
lobbyists, but in practice, they are all part of the conservative
movement. They are prosecuting its interests; that is the ur-goal.

Indeed, the far right rejects the very idea of neutral,
binding arbiters; there is only Us and Them, only a zero-sum contest for
resources. That mindset leads to what I call “tribal epistemology” — the systematic conflation of what is true with what is good for the tribe.

Hear, hear. This is not symmetrical. No, both sides don't do it. They exist in different epistemological universes, one the legacy of the Enlightenment, the other the legacy of the 12th Century. That's where we are in this country.

Thursday, November 09, 2017

John Ehrenreich in Slate has an interesting essay on why conservatives are more likely to believe stuff that isn't true. This is actually something of a tautology because believing stuff that isn't true is more or less the definition of "conservative" nowadays, but I suppose it's worth asking how it got that way. Excerpt:

[A]t the most basic level, conservatives and liberals seem to hold
different beliefs about what constitutes “truth.” Finding facts and
pursuing evidence and trusting science is part of liberal ideology
itself. For many conservatives, faith and intuition and trust in
revealed truth appear as equally valid sources of truth.

Ehrenreich associates this psychological tendency with submission to authority, in other words conservatives tend to believe what people in authority (within their world) tell them to believe. They believe their preachers, and Donald Trump, for example. In general, they are less inclined to critical thinking and more inclined to tribalism and motivated reasoning. During the election, many purveyors of fake news who were only in it for the clicks and the money tried putting out fakery that might appeal to both Democrats and Republicans; but only the pro-Trump material got results. You will never see the equivalent of the Comet Ping Pong pizzeria pedophilia ring hoax, or birtherism, or "death panels," get over on liberals.

True, some people on both the left and right thought the official story of the 9/11 attack was fake, and some people -- again, left and right -- continue to doubt the official account of the Kennedy assassination. In my view what we are told about these events is more or less the truth, though likely incomplete; but doubt about these events is not nearly as preposterous as birtherism or pizzagate.

We have a problem, however, if some 35-40% of the population is simply never going to believe certain plain facts. What happens when Robert Mueller proves the corruption of the Trump campaign and the candidate, and they simply won't believe it?

Wednesday, November 08, 2017

So a year ago we woke to the horrific, unbelievable reality of a candidate whose electoral rallies were filled with Confederate flags, who exhorted his followers to beat up protesters and reporters from the podium, who flung racist and misogynist insults, who threatened to prosecute his opponent, a manifest idiot and ignoramus with no knowledge or interest in public policy whose promises ranged from inane to impossible, a malignant narcissist whose only evident motivation was power and adulation, a sexual predator, a habitual and remorseless liar, a vulgar repulsive thoroughly evil lunatic, had managed to capture the presidency of the United States.

So obviously I don't think very highly of the Resident. But guess what -- I don't think much of people who voted for him either. Sure, many of them were to some extent victimized by propaganda -- some of it fueled by Russia. Many of them were bamboozled by the phony scandal about Hillary Clinton's e-mails and the relentless campaign of Clinton hatred the corporate media had engaged in for the past two decades. A small number of them, I suppose, really did believe they were going to get their old factory or mining jobs back with a decent wage, health care and a pension. (Though I largely doubt that.)

But mostly, they cheered on the racism. They cheered on the misogyny. They admired the bullying, the insults, the strong man posturing. They wanted to see women and negroes and Mexicans put in their place. They hated Muslims. They were excited by all the idea of beating foreigners and white ascendancy and male privilege. They were indeed deplorable, and so is every single person who still admires and endorses the Trump presidency. Really. You are disgusting. You can fix that. Wake up.

Tuesday, November 07, 2017

By now you have probably heard about, maybe even read, Dylan Farrow's new story in the New Yorker, "Harvey Weinstein's Army of Spies." In case you are too busy destroying your stash of Miramax DVDs to read the whole thing, it turns out that Weinstein hired "corporate security firms" -- i.e., private spooks including one firm that consists of former Mossad agents -- to try to dig up blackmail material on women he assaulted and reporters who might be inclined to write about it.

Their tactics included assuming false identities, pretending to befriend victims, notably Rose McGowan, or to be victims who were approaching reporters. I don't know if all this makes Weinstein out to be any more of a scumbag than we already know him to be -- presumably if you're a serial sexual predator and you're rich enough you'll invest in whatever it takes to try to get away with it. But this does introduce us to a whole new class of scumbags, including the attorney David Boies who apparently coordinated the whole effort, while simultaneously representing the New York Times. (And the NYT is righteously pissed off about it, BTW.)

There are people who will simply do anything for money. Maybe all this is not illegal, but you know the guy really did assault these women or he wouldn't be hiring you to do this, and once you trick McGowan into thinking you're her friend, you'll know it for damn sure. So you are in the employ of a serial rapist and you are making your living trying to help him cover it up so he can keep doing it. Then you go home at night to your family.

So, not that there was any danger of this happening, but don't hire David Boies.

Wednesday, November 01, 2017

William Saletan is not actually my favorite writer, but he does a good job on the liar and coward part. Kelly lied about Rep. Frederica Wilson, his lie was exposed and proven to be a lie beyond any doubt. Now he claims to have witnesses who will confirm that something which wasn't actually what he said originally is true, but he won't say who they are or how he knows that they can confirm his claim; whereas the mayor of Miramar, who was present, has come forward to say that Kelly is indeed lying. As Saletan puts it:

Kelly publicly invokes unspecified allegations by anonymous witnesses.
If he has witnesses, he should present them. If he won’t put them on the
record—or at least specify where and when they claim Wilson made the
statements he attributes to her, so that reporters can check out their
stories—then he’s just compounding his smear. There’s nothing honorable
or trustworthy about claiming to have secret evidence. And it’s
particularly damning that Kelly has retreated to unfalsifiable
allegations after his falsifiable allegations were discredited.

As for the racist part, perhaps there is room for doubt that there is a racist undertone to Kelly's lies about Rep. Wilson. But there is no room for doubt about this. Kelly told Faux News propagandist Laura Ingraham:

I would tell you that Robert E. Lee was an honorable man. He was a man that gave up his country to fight for his
state, which 150 years ago was more important than country. It was
always loyalty to state first back in those days. Now it's different
today. But the lack of an ability to compromise led to the Civil War,
and men and women of good faith on both sides made their stand where
their conscience had them make their stand.

Lee of course did not fight for his state, but for the Confederate States of America, a treasonous alliance that existed for the sole purpose of preserving and defending the institution of slavery. His conscience told him to defend slavery, which means that he was not an honorable man. And one demands to know what sort of "compromise" Kelly has in mind about slavery.

Maybe it doesn't shame a four-star general to be a racist. But a liar and a coward?

Update: I anticipate someone coming along and claiming that the cause of the Confederacy wasn't really slavery. Read this.